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HomeMy WebLinkAbout10 October Health & Human Services HEALTH BOARD MINUTES OCTOBER 24, 1995 BOARD MEMBERS: Robert Hinton, Chairman Richard Wojt, Member Glen Huntingford, Member STAFF MEMBERS David Specter, Health Department Director Jean Baldwin, Director of Nursing SelVices Larry Fay, Director of Environmental Health Chester Prudhomme, Director of Substance Abuse J. Peter Geerlofs, M.D., Health Officer CITY OF PORT TOWNSEND REPRESENT A TTVE: Bob Sokol The meeting was called to order by Chairman Robert Hinton and the following Board and staff members were present: Commissioner Glen Huntingford, Larry Fay, Jean Baldwin, Bob Sokol, Monica MacGuire and Judi Morris. APPROVAL OF MINUTES: Commissioner Huntingford moved to approve the minutes of September 26, 1995 as presented. Chairman Hinton seconded the motion. The motion passed. PUBLIC COMMENT PERIOD: Bob Reed commented on the dumping of garbage on County roads and private property due to the rising costs of fees at the landfill. Mr. Reed asked why the County doesn't add a fee to the property taxes and let the public dump for free? Maybe that would take care of the dumping on public and private property. Mr. Reed wanted to know if there was an easier way to renew a septic permit? Under current Permit Center policies, if you do not have a septic system in place, after three years, you have to reapply, pay the permit fees, and have the site reinspected. He feels this is a waste of time and money. Monica MacGuire, 'Permit Coordinator, suggested that the Permit Coordination Division meet with Larry Fay, Linda Atkins and Randy Marx to begin working on process improvements to resolve the questions that Mr. Reed and the general public may have. Commissioner Huntingford indicated that he thought that was a good idea. DIRECTOR'S REPORT FINANCIAL REPORT: Judi Morris reported that 75.7% of the budget has been expended and 68% of budgeted revenues have been collected. HEALTH ENVIRONMENTAL DEVELOPMENTAL DEPARTMENT HEALTH DISABILITIES 206/385-9400 206/385-9444 206/385-9400 ALCOHOl/DRUG ABUSE CENTER 206/385-0650 FAX 206/385-9401 HEALTH BOARD MINUTES - OCTOBER 24, 1995 Page: 2 ENVIRONMENTAL HEALTH DIRECTOR'S REPORT Lany Fay stated that in 1993 the County adopted a policy to review two party wells locally, using some of the State Department of Health standards. Within the last year there have been a number of revisions to the State Drinking Water regulations and the Group B regulations including an amendment to the section that allows the State Department of Health to waive requirements for two party wells in areas where they have assumed responsibility. Larry Fay discussed the letter he received from the State Department of Health (See Attached). He asked if the County wants to follow suit and void the policy adopted in 1993, amend our joint plan of operation with the State Department of Health and waive the requirements on two party wells, although wells would still have to meet the general criteria of the Department of Ecology regulations. Commissioner Huntingford asked if a two party well would be considered exempt? Larry Fay answered yes, it would be exempt and not subject to any rules of the State Department of Health in terms of public water supplies. The Board directed Lany Fay to draft a policy statement for adequacy, that reflects two party wells, and have it ready for the November Health Board meeting. Bob Reed asked if a person could have a three party well off of a good system? Larry Fay said, no, that a three party well becomes the threshold instead of a two party well. NURSING DIRECTOR'S REPORT Jean Baldwin discussed the final report of the University of Washington Robert Wood Johnson Foundation Project Analysis of the Jefferson County Health Department (see attached). Jefferson County was one of six counties to receive this audit. Some highlights include: Community Capacity, are there enough doctors in Jefferson County to handle health care? Health Surveillance and Assessment, this would be a position, funded 60% by Jefferson General Hospital and 40% by the County, and housed at the Jefferson County Health Department. This person will set up systems to analyze data on health indicators; Health Officer, a spokesperson for public health. The Health Department is trying to renegotiate Peter Geerlofs' contract to act as the spokesperson. Commissioner Huntingford asked how this is funded? Jean Baldwin explained that the money comes out of a three-year capacity fund, which helps get the program started and then the Commissioners decide how and where they will use the money locally. This would not be a County employee. A person would be contracted to perform these functions, with Jefferson General Hospital paying the majority of the contract. This will be discussed at a future Health Board meeting. Flu Clinics are available to Jefferson County employees and due to the rising costs of Health care there will be a charge of$10.00. Jean Baldwin reported on the Youth Network Services meeting and stated that any correspondence received, she forwards to Gary Rowe, Director of Public Services. Chairman Hinton asked if there is funding available for the Bregita House Program for youth in Jefferson County. Jean Baldwin stated that the Youth Network Service will not fund a project unless it is preexisting and Bregita House is not. HEALTH BOARD MINUTES - OCTOBER 24, 1995 Page: 3 NEW BUSINESS Commissioner Huntingford said he talked with Glenda Birch of the Governors Rural Community Assistance Team, and there is $10,000 available to timber dependent counties. If the Health Department has not applied for this grant, they need to before the funds are allocated elsewhere. Jean Baldwin will have David Specter look into this matter. Larry Fay discussed nitrogen impacts from on site sewage systems and different treatment systems. He wants to see a program set up to monitor the effectiveness of nitrogen removal and would like the Commissioner's support for future funding. Larry Fay will gather more information and present it to the Board at a later meeting. The next meeting will be held on Tuesday, November 28,1995 at 1:30 p.m. N COUNTY BOARD OF HEALTH .- University of Washington Seattle, Washington 98195 School of Public Health and Community Medicine Health Policy Analvsis Program Department of Health Services, JD-43 (206) 543-3670 FAX: (206) 543-9345 PERSONAL CLINICAL HEALTH SERVICES TECHNICAL ASSISTANCE PROJECT Jefferson County Health Department METHODOLOGY The Washington state Department of Health has contracted with the University of Washington Health Policy Analysis Program (HPAP) and the Washington State Association of Local Public Health Officials (WSALPHO) to work with local health departments as they assume new roles in the state's public health system. Financed by Title V (maternal and child health) support and a two-year implementation grant from the Robert Wood Johnson Foundation, the long-term goal of the technical assistance project is to assist local health jurisdictions as they adjust to rapidly changing political and economic environments. This work begins with a series of visits by the technical assistance project team to individual health departments to meet with local public health officials, health care providers, and community leaders. Many local health jurisdictions, which are developing policies that focus on the core functions of public health, are shifting responsibility for provision of personal clinical health services to private sector providers. They are also considering what personal services should continue to be provided by public sector agencies. The purpose of these initial meetings is to define the factors local health jurisdictions will consider as they perform this transition. The project Steering Committee selected the Jefferson County Health Department as one of six local public health jurisdictions in the first round of site visits during 1995. The project team visited the community on February 24 and 28 and on April 3, meeting with department personnel, representatives from community agencies, and local providers. This report relates the issues raised by respondents during this process. These issues range from internal agency policies, to the impact of Medicaid managed Emblem: . . a North'west Coast Indian symbol of physical and mental weU.being. Artist: Marvin OliVl:f care, perceptions of community capacity, and the local community dynamic shaping public health's role. (See Attachments for a list of individuals participating in interviews, and the project Steering Committee.) DESCRIPTION OF CURRENT STATUS OF CLINICAL SERVICES The Jefferson County Health Department provides WIC, maternity support services, and maternity case management associated with more than 90% of the county's births, all the immunizations in the county, and various services for children with special health care needs. The department closed its well-child clinic at the end of 1994 following implementation of Medicaid managed care, transferred staff successfully to provision of family planning services, and may transition family planning and immunization services to private providers once their capacity increases. HEALTHY OPTIONS IMPLEMENTATION Jefferson County has been participating in Medicaid managed care since December 1989, when it joined the Sound Care Plan that had already taken effect in Kicsap and Mason Counties. (Medicaid client groups in Jefferson County continued to enroll through January 1994.) The Sound Care Plan was the state's first experience with mandatory Medicaid managed care, which in this case is administered by the Kitsap Physicians Service, a medical service bureau in which all Jefferson County physicians are enrolled. Today, there are about 1,500 Jefferson County residents enrolled in KPS!Healthy Options. KPS did not invite the health department to participate as a Healthy Options provider, but the department provides clinical services outside capitation to Medicaid clients who self-refer. Following are issues raised during the project team's site visit. By Health Department staff: o Health department management reported that they have a generally distant and at times a competitive relationship with KPS, which remains the county's sole provider for both the Healthy Options program and the Basic Health Plan. Department case managers, however,. work closely with KPS primary care physicians to coordinate services for high-risk women and families. o One department staff member perceived that EPSDT exams conducted by the county's private providers since the closure of the health department's well-child clinic are of poor quality, land last only about 10-15 minutes, compared with 40 minutes for the exams that .' were conducted by the department. o KPS still refers to the health department for immunizations, a practice that staff said continues because the private Healthy Options providers are too busy, or because they prefer the department to manage and track related "paperwork." By community providers: o One provider said that no one locally is ensuring that residents who are eligible for Medicaid are actually enrolling in the program. o The local hospital administrator told the site visit team that he has no reliable data base that shows which patients are enrolled in Healthy Options, nor does he know whether the program has expanded access locally. The hospital has been experiencing a decline in admissions financed by Medicaid; the administrator doesn't know whether the drop means that Medicaid clients are facing new barriers to access or whether KPS is successfully managing care so that fewer clients need inpatient services. . By community agency representatives: o Implementation of Healthy Options and closure of the well-child clinic may have affected Child Protective Services referral rates, especially outside Port Townsend, reports a local CPS case worker. o According to Jefferson County Network data, the number of CPS cases since 1992 has increased, while over the same period, health care provider (medical) referrals have decreased. o A local school district official said that she was sorry to see the health department's well-child clinic close down. There are now problems identifying needs in the 0-3 population. She added that implementation of Healthy Options has made little difference to access in rural areas, because of transportation barriers. o The local Head Start director said that the closure of the health department's well-child clinic has affected the pre-school program, which relied on department services. provision of WIC services has been disrupted, and they have received reports of incomplete physicals, difficulty obtaining appointments, and poor follOW-Up by physicians. The health department still conducts some health screens 3 .' and provides some dental care to Head Start children. COMMUNITY CAPACITY Currently, no consensus exists among providers as to whether Jefferson County has sufficient capacity to meet all its health needs. Nor is there local agreement on whether community providers can absorb the clinical services that the health department still provides. A volunteer Saturday clinic operates out of the American Legion Hall. It was launched in November 1994 at the instigation of a local physician and under the umbrella of the Community Action Agency to serve those who have no other source of care than the emergency room. The health department, the local hospital, and private providers declined to participate in the project, which they said would provide only episodic care. Elsewhere, current capacity is highly concentrated in Port Townsend, and residents of rural areas experience severe access problems. Since our site visit, the health department has begun offering clinics in Quilcene (south county): WIC is offered once a month; family planning clinics are available twice a month; and maternity support services, immunizations and home visits are available four times a month. These clinics are very well received by the . community and will soon expand to include drug and alcohol assessments. Issues raised during site visits: By Health Department staff: o The Health department's health officer said he perceives that there is adequate capacity in the community to take over any of the "primary care" activities the department currently performs. By community providers: o The local hospital administrator said that the community may have a problem with too many physicians, not too few. o Virtually the entire provider community in Jefferson County, including all the physicians, are located in Port Townsend. o Jefferson County hospital district. capital expansion. General Hospital is a public Local voters recently approved a 4 o Part-time clinics are feasible in the more remote rural areas of the county, according to a local .physician. But clinics in Quilcene and Port Ludlow have experienced low demand. o One Port Townsend family practice sees 90% of the community's AIDS patients. The practice is working beyond its capacity and cannot take on any new responsibilities. o One provider sees the health department as primarily nursing driven, well credentialed, with high standards and integrity. In his opinion, the health department's strengths are outreach, community clinics, education, and serving the disenfranchised populations. He does not believe that local providers have the time nor the training to educate or be advocates for their clients. He did not think that there were enough "numbers" in the rural areas to support any full time outreach programs. By community agency representatives: o There are many unmet needs in the community, especially given Jefferson County's geography, which isolates some of the county's rural sections. o A local clergyman said it is his perception that new physicians moving into the community are often "frozen out" of existing provider networks and refused hospital privileges by established physicians who want to protect their turf. o Less than 20% of the families referred locally to Child Protective Services say that they have physicians; about 5% have medical problems, according to a case worker o A school district official, suggested that the health department could deploy a van to outlying areas to conduct health screens of school children. o While there may be enough doctors per capita, there aren't any in Brinnon and the residents do not necessarily have access to the Port Townsend doctors. o About 60% of the families in Brinnon are living in poverty. Of those, only about half are on Medicaid. Others may qualify but choose not to participate . However, these same families have a positive perception 5 of public health services; they already pay taxes to support the public health system and feel more comfortable receiving services through the health department. o Since the Well Child Clinics have been discontinued in Brinnon, there is no longer any consistent contact with the health department, nor any continuity of care for the area children. Families are relying on local EMTs for primary care. COMMUNITY INTERACTIONS Jefferson County Health Department's governing body is the board of health, which is the County Commission. The BOH members do not have a public health policy background, but the department attends its monthly meetings in the county courthouse and clarifies issues when possible. Expectations of a future role for public health vary widely in the community. The BOH's visions for the department range from maintaining a traditional role of provider of last resort to simply closing down and turning over all its responsibilities to the private sector. A local clergyman believes the department should provide space for a free clinic. A state Department of Social & Health Services (DSHS) representative sees it as the eyes and ears of the community. And a hospital administrator views the Jefferson County Health Department as a collector of health data. Issues raised during site visits: By Health Department staff: o Jefferson County government perceives the health department as too big, and it wants to reduce local spending on public health. The county provides about 23% of the department's $2 million budget; the city, 5%; about 15% comes from fees; and the balance from state grants, o A Community Advisory Committee was convened in 1993 to complete APEX/Part II and to guide local implementation of the PHIP. o The department has been successful at achieving productive partnerships with community groups, many of which use its new facilities during evenings and weekends. By community providers: 6 . , o To one local physician, the health department appears to be nursing-driven and strong in outreach, education, and providing services to disenfranchised populations. o As use of capitation spreads, more local providers will embrace services that keep people well, said the physician. o Jefferson County's provider community has been characterized recently by physicians moving away or retiring. For patients who can wait for routine care, this poses no problem. Those with acute needs face access problems; there are no walk-in clinics locally except for the hospital emergency room [and the voluntary, one-day-a-week clinic] . o The health department is able to invest time in health education, which physicians are not trained to do, one provider noted. o Local health care services in Jefferson County have been based on a paternalistic approach, said a local hospital administrator. In the future, they will be based on a community approach. . o Local providers agreed that the health department should rema~n involved in community education, outreach (including helping to overcome barriers to access), case management (across a variety of services), special studies, and general health status monitoring. By community agency representatives: o The board of health needs guidance in its new role, according to a former city official. Currently, city- county differences in policy hinder community-wide solutions cO problems. o The health department could coordinate collaborative endeavors across county departments, said a representative of the local Community Action Agency. o A local clergyman believes the health department could playa more significant role in the community in making services available to disenfranchised people. o A school district administrator reported that about 60% of Brinnon children live in poverty. Jefferson County has high unemployment, and available jobs are often in the poorly paid service sector or seasonal work. Now that the health department has closed its well-child clinic in the area, the only available 7 health services are for basic screening, she noted. o A community official expressed concerns that as health department policies change, its mission may narrow so that it stops addressing such issues as prevention of teen pregnancy and substance abuse. HEALTH SURVEILLANCE AND ASSESSMENT The health department recognizes the central role of assessment in the Public Health Improvement Plan and its importance in assisting the community in establishing health priorities. The health department seeks to build its capability to collect and process information on community demographics, health status, and access to care. Its director would like to develop a permanent staff position to analyze data, including basic demographic trends. Community leaders stated frequently in the course of interviews that data management is an appropriate role for the health department and one the community would support. Issues raised during site visits: By Health Department staff: o The department's director and staff want to restructure their organization around the core functions of public health, focusing particularly on health promotion. They are structuring capacity to improve the analytical and health promotional functions of the health department. o Surveillance and assessment are likely roles for staff to assume as the health department transitions out of clinical services. o Staff said that the high infant mortality rates in Jefferson County could become an issue through which the health department could begin to develop a new leadership role as convener, negotiator, data collector and analyst, and educator. o A Port Townsend City Council member attending a recent board of health meeting asked whether the health department would include gun violence in its data gathering and community assessment. 8 By community providers: o The understanding of provider capacity is seriously hindered by the lack of service data in the community. The health department is expected to be a major player in collecting and analyzing data as part of its assurance function. o The local hospital administrator said that the community lacks sufficient epidemiological data, an area where the health department should provide leadership. Patient data should originate with physicians; automated records systems would assist this process. The health department would be a repository of data, with local providers and other serving as partners in collecting information and financing this activity. By community agency representatives: o A CPS official expressed concern that a reduction in public health outreach work would affect its ability to monitor children's issues in the community. OBSERVATIONS Based on its analysis of information collected during site visits and subsequent interviews with community contacts, the technical assistance project team offers these observations about issues relevant to the health department's emerging role in the public health system: o Given the very different visions that department staff, community providers, and community leaders have for the Jefferson County Health Department, there is a need to educate, to negotiate, and to elicit agreements among stakeholders, county officials, and the community on the future role of public health in Jefferson County. The community members interviewed have strong feelings and specific ideas for structuring health care services. A community process promoting public participation could help the health department determine its vision for the future. . The health department could improve communication and collaboration with local providers by strengthening the role of its health officer to ~represent public health" in the community. A "strong" public health -focused health officer can become a recognized spokesperson for public health, a respected liaison between public 9 . health and colleagues in private practice, and strengthen the credibility of public health by reliably carrying out the responsibilities of the local health officer as directed in RCW 70.05.040. o The board of health needs to understand how changing public health policies will affect their local agency's access to state and federal financing and its accountability for the funds. Rather than accounting for spending based on numbers of exams or immunizations provided, for example, the health department will in the future report how its activities affected the health status of its community. At the same time, the community needs to be reassured that this redefinition of what a "public health service" is" will not increase problems of access to services. o Local government support for public health finances categorical programs. Local officials have not yet developed plans to supplant those funds to finance the Health department of the future. o Jefferson County does not currently have good health data. Good public health policy that can positively impact the health status of a community must be based on reliable, standardized health data. The health department is perceived by the community as an appropriate agency to collect and process information on community demographics, health status and access to care. This role dovetails with the health department's goal to build its core function capacity. 10 Personal Health Services Transition Technical Assistance Project Jefferson County Interviews Health Department Staff David Specter, Director Jean Baldwin, Nursing Director Larry Fay, Environmental Health Director Peter Geerlofs, M.D., Health Officer Board of Health Bob Hinton Glen Huntingford Richard Wojt Other Goverr~ent Representatives Norma Owlsley, Former Port Townsend City Council Member Diane Perry-Thompson, Port Townsend City Council Staff Liaison to Health Department Providers Victor Dirksen, Administrator, Jefferson General Hospital J. Randall Jacobs, M.D. Community and state program contacts Janet Anderson, Director, Clallam-Jefferson Head Start Jack Gray, DSHS Childrens Protective Services District Manager Howard Fosser, Pastor, Grace Lutheran Church Mel Herod, Brinnon Fire District Chief Dr. Carolyn Insler, Brinnon School Superintendent Kim Rafferty, RN, Clallam-Jefferson Head Start, Health and Nutrition Specialist 11